Standardized Volar Silicone PIP Arthroplasty: Bilateral Proximal Collateral Release and a Structured Non-Repair...

Area of Science:

• Orthopedic Surgery
• Hand Surgery
• Reconstructive Surgery

Background:

• Traditional dorsal approaches for proximal interphalangeal (PIP) joint silicone arthroplasty disrupt the extensor mechanism, potentially causing stiffness and extension lag.
• Existing volar techniques lack standardization in managing soft tissues like the flexor sheath, volar plate, and collateral ligaments, hindering reproducibility.

Purpose of the Study:

• To describe a standardized, reproducible volar surgical technique for PIP joint silicone arthroplasty.
• To detail a method that preserves the extensor apparatus and facilitates early active mobilization.
• To present a soft-tissue rebalancing strategy for improved implant placement and joint stability.

Main Methods:

• A standardized volar approach involving controlled neurovascular mobilization.
• Elevation of the A3 pulley as a flap, preserving A2 and A4 pulleys.
• Proximal volar plate disinsertion and bilateral collateral ligament detachment for symmetric exposure.
• Retraction of flexor tendons without division, followed by implant insertion and stability assessment.

Main Results:

• The described technique provides reproducible volar exposure for PIP joint silicone arthroplasty.
• Collateral ligament release allows correction of deformities and restoration of coronal balance, aiding centered implant placement.
• The method facilitates assessment of axial alignment and stability throughout the range of motion.

Conclusions:

• This standardized volar technique offers a reproducible method for PIP joint silicone arthroplasty with effective soft-tissue rebalancing.
• The approach preserves critical extensor structures and allows for optimized implant positioning.
• Clinical success is contingent on achieving intraoperative soft-tissue balance and implant-centered stability.